Related Experiment Video
Updated: Jul 28, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Is provisional stenting the effective option? The WIDEST study (Wiktor stent in de novo stenosis). Widest Trial
Insights
Routine stenting and provisional stenting show similar long-term outcomes for coronary artery disease patients. Balloon angioplasty alone is effective, offering potential cost savings and comparable results to stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery disease management often involves percutaneous coronary intervention.
- Balloon angioplasty and stent implantation are key revascularization techniques.
- The optimal strategy between routine stenting and provisional stenting remains an area of investigation.
Purpose of the Study:
- To compare immediate and late outcomes of routine stent implantation versus routine balloon angioplasty.
- To evaluate the efficacy of using stents only when an ideal result is not achieved with balloon angioplasty.
Main Methods:
- A nine-center, multinational, randomized study involving 300 patients with single-lesion coronary artery disease.
- Inclusion criteria: suitability for balloon angioplasty or stent implantation, new lesions, no prior bypass surgery.
- Exclusion criteria: totally occluded vessels.
Main Results:
- Elective stenting achieved a greater initial restoration of luminal diameter compared to balloon angioplasty (MLD 2.68 mm vs 2.27 mm).
- Late luminal loss was greater in the stent group; angiographic benefit disappeared by six months (MLD 1.90 mm vs 2.00 mm).
- Both groups showed similar symptom relief (58.9% improved) and need for revascularization at one year (18.2% vs 17.1%).
- Hemorrhagic complications were equally distributed between anticoagulation and antiplatelet groups.
Conclusions:
- Provisional stenting offers comparable long-term outcomes to elective stenting in selected patients.
- Conventional balloon angioplasty has improved, making a stent-sparing approach practicable and cost-effective for many.
- The study supports a strategy of provisional stenting based on achieving an ideal result.
Aim:
To compare the immediate and late outcomes of patients treated by a policy of routine stent implantation with routine balloon angioplasty and the use of stents only when an ideal result has not been obtained.
Methods:
A nine centre, multinational, randomised study of 300 patients with coronary artery disease thought suitable for treatment of a single lesion by balloon angioplasty or stent implantation. Only new lesions in patients who had not undergone previous bypass surgery were included, and totally occluded vessels were excluded.
Results:
The initial procedure was considered successful in 96% of patients. There was more complete angiographic restoration of luminal diameter in patients treated by elective stent (minimum lumen diameter (MLD) 2.68 mm for stent v 2.27 mm for balloon; p < 0.007), but analysis of the subgroup of balloon angioplasty patients who crossed over to stenting showed that they achieved similar results to the elective stent group. Late luminal loss was greater in stented patients than in those undergoing balloon angioplasty only, and by six months the angiographic benefit of stenting had disappeared (MLD 1.90 mm for stent group v 2.00 mm for balloon angioplasty). Angiographic and clinical results in the balloon angioplasty group were assisted by the high crossover rate (30.1%). Both groups had similar symptom relief, with 58.9% of patients improving by two or more angina grades. The need for further revascularisation was also similar in the two groups at one year (18.2% in the stented group v 17.1% in the balloon angioplasty group). Haemorrhagic complications at the local arterial entry site were more common than expected and were distributed equally between the patients receiving full anticoagulation and those receiving antiplatelet treatment only. The results of both Wiktor stent placement and balloon angioplasty were similar to the findings in the stent group in previous randomised studies (Benestent II, STRESS).
Conclusions:
Provisional stenting appears to offer the same longer term outcome as elective stenting in this selected group of patients. Improvement in the results of conventional balloon angioplasty in the past 10 years means that a policy of obtaining an ideal result without the use of stents appears to be practicable in many of these patients, with consequent cost savings.
